年龄和纤维化指数预测乙型肝炎病毒 DNA 高但丙氨酸转氨酶正

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年龄和纤维化指数预测乙型肝炎病毒 DNA 高但丙氨酸转氨酶正常的患者肝细胞癌风险

Seong, Gyeol,*; Sinn, Dong Hyun,*;康元锡； Gwak, Geum-Youn;崔文锡；李俊赫； Koh, Kwang Cheol; Woon Paik, Seung;白勇汉
作者信息

韩国首尔成均馆大学医学院三星医疗中心医学系

2020 年 3 月 18 日接收 2020 年 6 月 16 日接受

* Gyeol Seong 和 Dong Hyun Sinn 对本文的撰写做出了同等贡献。

致函韩国首尔江南区 Irwon-ro, 81, 06351, Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Medicine, Yong-Han Paik, MD, PhD, 电话：+82 2 3410 3409；传真：+82 2 3410 6983；电子邮箱：[email protected]
欧洲胃肠病学和肝病学杂志：2022 年 1 月 - 第 34 卷 - 第 1 期 - 第 69-75 页
doi：10.1097/MEG.0000000000001915

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抽象的
目的

乙肝 e 抗原 (HBeAg) 阳性、血清乙肝病毒 (HBV) DNA 水平高但丙氨酸转氨酶 (ALT) 水平正常的慢性乙型肝炎患者可能会发展为肝细胞癌 (HCC)。然而，风险分层的方法是有限的。
方法

对 651 名血清 HBV DNA 水平高 (>7 log IU/ml) 但 ALT 水平正常或轻​​度升高 (<80 U/L) 的 HBeAg 阳性成年患者的回顾性队列进行了分析。
结果

年龄和 FIB-4 指数是与 HCC 发展相关的独立因素。分层时，年龄<40 岁且 FIB-4 指数 <1.45 的患者的 5 年和 10 年累积 HCC 发病率分别为 0% 和 2.0%，而 FIB-4 指数 ≥ 40 岁的患者的 5.9% 和 32.7% 为分别为 1.45 (P < 0.001)。在ALT水平正常的患者（n = 301）中，年龄<40岁且FIB-4指数<1.45的患者10年HCC发病率为0%，而5年和10年HCC发病率为4.5和27.1 FIB-4 指数≥1.45 的年龄≥40 岁患者的百分比分别为 (P < 0.001)。
结论

在 HBV DNA 高但 ALT 水平正常的患者中，年龄和 FIB-4 指数可以有效地分层 HCC 风险，表明这些参数可以指导该人群的管理计划。

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Age and fibrosis index for the prediction of hepatocellular carcinoma risk in patients with high hepatitis B virus DNA but normal alanine aminotransferase

Seong, Gyeol,*; Sinn, Dong Hyun,*; Kang, Wonseok; Gwak, Geum-Youn; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Woon Paik, Seung; Paik, Yong-Han
Author Information

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Received 18 March 2020 Accepted 16 June 2020

*Gyeol Seong and Dong Hyun Sinn contributed equally to the writing of this article.

Correspondence to Yong-Han Paik, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351, Seoul, South Korea, Tel: +82 2 3410 3409; fax: +82 2 3410 6983; e-mail: [email protected]
European Journal of Gastroenterology & Hepatology: January 2022 - Volume 34 - Issue 1 - p 69-75
doi: 10.1097/MEG.0000000000001915

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Abstract
Aim

Chronic hepatitis B patients positive for hepatitis B e antigen (HBeAg) with high serum hepatitis B virus (HBV) DNA levels but normal alanine aminotransferase (ALT) levels may develop hepatocellular carcinoma (HCC). However, ways to risk stratify are limited.
Methods

A retrospective cohort of 651 HBeAg positive, adult patients with high serum HBV DNA levels (>7 log IU/ml) but normal or mildly elevated ALT levels (<80 U/L) were analyzed.
Results

Age and FIB-4 index were independent factors associated with HCC development. When stratified, 5- and 10-year cumulative HCC incidence rates were 0 and 2.0% for patients aged <40 years with FIB-4 index <1.45, and were 5.9 and 32.7% for patients aged ≥40 years with FIB-4 index ≥1.45, respectively (P < 0.001). In patients with normal ALT levels (n = 301), the 10-year HCC incidence rate was 0% for patients aged <40 years with FIB-4 index <1.45, while 5- and 10-years HCC incidence rate was 4.5 and 27.1% for patients aged ≥40 years with FIB-4 index ≥1.45, respectively (P < 0.001).
Conclusion

In patients with high HBV DNA but normal ALT levels, age and FIB-4 index could effectively stratify HCC risk, indicating that these parameters may guide management plans for this population.